Surgical management of hemorrhoids. State of the art.

Hemorrhoidal disease, with an incidence of 4% of global population, is a common problem in the western world 1. It can be successfully managed by means of conservative measures, including fibres, sclerosing injection, rubber band ligation and infrared coagulation, in almost 90% of the cases 2-7. Hemorrhoidectomy (HC) is still considered the gold standard 8 and is the most used operation by Italian coloproctologists 9. Among manual open and closed hemorrhoidectomy (HC), the Milligan-Morgan and Ferguson procedures have been the most widely used operations carried out for decades 10-14, but, as postoperative pain is feared by the patient, novel procedures advertised as “painless” had been proposed, usually based on costly devices. Among them, stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH), based on stapled mucosectomy 15,16 and doppler-guided hemorrhoidal artery ligation, Pervenuto in Redazione Dicembre 2010. Accettato per la pubblicazione Gennaio 2011 Correspondence to: M. Pescatori, Coloproctology Unit of Ars Medica, Via C. Ferrero di Cambiano 29, 00191 Rome, Italy (e-mail:ucpclub@virgilio.it). Alberto Arezzo**, Vlasta Podzemny*, Mario Pescatori*